I got a text from my sister: On Friday, our Oma was going to die.
It was a Wednesday when I got the text from my sister: Our Oma was going to die on Friday, and that was that. Forty-eight hours to process the news and anticipate her final moments.
The Atlantic Ocean separated me from my Oma for most of my life; I grew up in the United States, and she stuck with her deep, Dutch roots in the Netherlands. Still, some things about her, I'll never forget. She loved the soap opera As the World Turns. She kept an entire pull-out cabinet full of cookies and crackers in the kitchen when we were kids, and if you looked long enough, you would always find a tin of butter cookies somewhere. Her hair was always colored, her outfits put together, and her makeup done. And Oma loved champagne. When she first met my boyfriend five years ago, she filled his flute time and again with a smile on her face, her way of breaking through the language barrier.
The most notable memories about my Oma are the ones I don't have. I don't remember her as angry, or bitter, or upset. I remember her laughter, and her humor, and her sweet demeanor. Maybe that's the grieving heart talking. But I think that's just who she was.
So when I found out that two doctors had approved my Oma's request for euthanasia—a term that's used proudly in the Netherlands—my heart broke. When I last saw her in April, she was still living independently in her second-floor apartment above a restaurant, but her sight and hearing were failing her: She kept confusing me for my sisters, Libby and Indy, and she couldn't carry on conversation at the table. Four months later, she moved into an assisted living home and had asked several doctors to help her die. Two doctors must approve the request under Dutch law, and when they did, Oma finally felt relief.
In the Netherlands, euthanasia is permissible in cases where the patient shows "lasting and unbearable" suffering with no hope for improvement, as outlined in the 2002 act that made this practice legal. In 2016, medically-aided deaths accounted for 6,091, or 4 percent, of all deaths in the country. (The Dutch have progressive ideas regarding death: There's even a legislative proposal called "Voltooid Leven," or "Completed Life," that would give everyone over the age of 75 the right to access euthanasia if they felt their life was "complete," regardless of a medical reason.)
That's not to say euthanasia is a lax procedure. "[People] should know about the careful process leading up to the decision of whether somebody's request is approved or not," says Annerieke Dekker of Levenseindekliniek, an end-of-life clinic in the Netherlands that helped 498 people die peacefully last year. The patient must be suffering, make a voluntary request, understand what they're asking, and have no other treatment options. "This process can take months, especially in complicated cases."
Euthanasia is legal in just four countries—Colombia, Luxembourg, Belgium, and the Netherlands—and it refers specifically to a doctor administering life-ending drugs to a patient, often through an injection. "That is not acceptable here," says Peg Sandeen, executive director of Death with Dignity, an Oregon-based organization that helps states adopt assisted dying laws and protects these laws from being overturned. "I can't imagine that happening politically. It has to be completely patient controlled."
In the United States, a patient-controlled option known as physician-assisted dying is legal in five states plus DC. (And last year, 30 states were considering adding similar laws to their legislation, Sandeen says.) Under these so-called death with dignity laws, a doctor can write a prescription for life-ending drugs, which the patient takes on his or her own terms—the difference is that patients take the medication themselves, rather than the doctor administering them directly.
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In Oregon, where the laws are most restrictive, a patient must be terminally ill with less than six months to live. They must be examined by a physician, make a verbal request, wait 15 days, visit a second physician, make a second verbal request, and make a written request. If everything checks out and the doctor confirms that the patient meets all the criteria, he or she can write a prescription 48 hours after the second request was made.
In the 1980s, Sandeen's husband was diagnosed with HIV and asked her to help him die, long before assisted dying laws were part of the political discussion. "Watching him experience protracted dying and the incredible amount of suffering that came along with his illness made me fully committed to death with dignity," she says. "Once you experience a dying process full of suffering, you want to make sure that nobody experiences that."
Forty-eight hours: That's all the time I had to prepare myself for my Oma's death. At least, that's how I saw it. But for my Oma, the pending, but definite "period" to her life was probably bittersweet: just two more days before her suffering would end. And isn't having that finite timeframe better than the open-ended question How long will this go on? After hearing how at peace and at ease my Oma was when her request was approved, I realize more than ever how beautiful an option assisted dying can be for people who are suffering. Death doesn't have to be a scary, daunting, painful event. Yes, it feels counterintuitive to think of death as a good thing, but in some cases, it truly is the best option. Assisted dying helps achieve that.
"I think it provides peace of mind," Sandeen says. "That peace of mind helps people to approach their death in a more comfortable manner." Two days before she died, Oma had her final farewell dinner with family. When she found out that the staff at Hamdorff, where she was a regular diner, offered the meal on the house, she joked that she should have done this—die—more often. Because she was at ease, Oma could still joke, she could still laugh, and she could still make light of the situation.
Death with dignity laws have big impacts on an individual level, but the ripple effects reverberate through the entire healthcare system. "There suddenly becomes this focus on how we die," Sandeen says. "Specifically in Oregon and Washington, we've seen improvements in end-of-life care across the board." In 2013, almost two-thirds of people who died in Oregon did so at home, compared to less than 40 percent in other states, according to a report published in March in the New England Journal of Medicine. And in Oregon and Washington, fewer patients were admitted to intensive care in their last 30 days of life and more patients were discharged home before dying than in any other state.
According to a 2017 Gallup poll, 73 percent of Americans think that when "a person has a disease that cannot be cured," a doctor should be allowed by law to end the patient's life painlessly at their request. That's up from 37 percent when the company first posed the question in 1947. Sixty-seven percent of Americans support physician-assisted dying under the same circumstances. Support is much lower (55 percent) among frequent churchgoers than among people with loose or no religious ties (89 percent). "This is deeply cultural, and the last thing we want to do is try to push this on anybody," says Thomas Preston, a medical advisor for End of Life Washington who helped pass the Washington Death with Dignity Act in 2008. "It's everybody's right to say, I don't want this. I think this is wrong."
Even in states where laws allow for physician-assisted dying, doctors aren't required to offer it and pharmacists aren't required to fill prescriptions, but they can refer patients to a medical professional who will. Those who don't support the law often use the word "suicide" to describe the practice, with terms like assisted suicide and physician- or doctor-assisted suicide. But suicide is a completely different scenario, often with a mental health component and usually done in secret with no proper chance to say goodbye, Preston says.
"People who suffer unbearably and unendurably come to the Levenseindekliniek with a request for help, not because they want to die, but because they can't handle life anymore," Dekker says. "They often come to us as a last resort." My heart is at once heavy and happy when I think of my Oma's death. She's gone. But she didn't have to continue living each day confused, alone, and in pain. I'm grateful Oma had the option to make this beautiful choice for herself.
In the Netherlands, euthanasia is a two-part process, Dekker says: First, the patient drinks a strong barbiturate solution, and slides into a coma. If the barbiturate is not enough, the doctor then gives two injections: an anesthetic, and a muscle relaxant.
On September 1st, my dad and his three sisters went to my Oma's apartment at the assisted living home. The doctor inserted a butterfly needle in case the injection was needed. Oma spent the morning with her kids, talking, laughing, and sipping—what else?—champagne. After a few hours, she climbed into bed and took the barbiturate solution. "What a delicious drink," she said. Thirty seconds later, her eyes closed. Two minutes later, her heartbeat faded. She was finally at peace.
In her eulogy, my sister, Libby, said it best: "Until the end, Oma was sweet. She was happy, positive, even funny, through her last moments. That was her personality. A personality to be celebrated. A life to be celebrated."
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